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Breast Exams
The average woman has one chance in nine (or about 11 percent) of developing breast
cancer during her lifetime. It is the most common type of cancer among American women.
Each year, more than 175,000 women in the U.S. learn that they have breast cancer.
Two-thirds of them will be over age 50. But breast cancer also occurs in younger women.
And in men, too.
While breast cancer cannot currently be prevented, it can be treated, if detected early.
Early detection is the key to survival.
Practicing breast exams helps increase your chances of detecting breast cancer in its
earliest stages. Only about 20 percent of biopsied breast lumps are cancerous. And, if
cancer is found
early, there are choices for treatment.
With prompt, appropriate treatment, the outlook is good. In fact, most women treated for
early breast cancer will be free from breast cancer for the rest of their lives.
The National Cancer Institute (NCI) suggests a three-point breast cancer detection plan.
Mammography is the key to detecting breast cancer at its earliest stage because it can
find a cancer up to two years before it can be felt.
Recent research on the benefits of mammograms for women younger than age 50, however, is
currently being analyzed by NCI and other health organizations.
The study, published in February 1993 in the Online Journal of Current Clinical Trials,
concluded that mammography screening for breast cancer offers no long-term survival
benefit for women in
their 40s, but that the test saves lives among women age 50 and older.
Currently, the American College of Physicians does not recommend mammograms for younger
women.
NCI, however, currently recommends that women should start having this test at age 40. For
women of all ages, other important exams include a breast examination by a doctor or other
health
professional and breast self-examination. These guidelines should be considered along with
your background and medical history.
NCI currently recommends the following plan:
Step One: Know when to obtain a mammogram
Beginning at age 40, all women should be encouraged to have a mammogram every 1 to 2 years
until age 50. After age 50, mammography should be done annually.
A mammogram is an x-ray of the breast. It can reveal tumors too small to be felt and can
show other changes in the breast that may suggest cancer.
In mammography, the breast is pressed between two plates; some pressure is applied to get
a clear picture. Usually, two x-rays are taken of each breast, one from the top and one
from the side. Although some women are concerned about radiation exposure, the risk is
very small.
Doctors recommend routine mammography because it is effective in finding breast cancer
early. Long-term studies have shown that using mammography along with a breast exam by a
health professional can reduce deaths from breast cancer among women.
These guidelines may change as new scientific information becomes available. The final
decision, however, regarding mammograms, should be made on an individual basis.
A doctor also may suggest a mammogram if a symptom of breast cancer is found, whether
through breast self exam (BSE), an examination by a physician, or by chance.
Step Two: The Physical Breast Exam
Women should have breast examinations by their physicians during routine checkups. Women
age 40 and older should have them annually.
The next step in early detection is breast examination by a health professional. You may
find it convenient to schedule this exam during your routine physical checkup. If a breast
exam is not done during that checkup, ask for one.
During the exam, the health professional feels the breast and underarm with the fingers,
checking for lumps. This is called palpation. The breasts also are checked for other
changes such
as dimpling, scaling, or puckering of the skin or a discharge from the nipples.
Step Three: Breast Self Exam (BSE)
Women should do breast self-examination monthly.
Breasts come in all sizes and shapes, just as women do. Your own breasts will even change
throughout your life. Your monthly menstrual cycle, menopause, childbirth, breast feeding,
age, weight changes, birth control pills, and other hormones may change the shape, size
and feel of your breasts.
It is important to learn what is normal for you. This can be done by doing breast self
exams. It is easy to do, and as the name implies, you do it yourself.
BSE is done once a month so that you become familiar with the usual appearance and feel of
your own breasts. Familiarity makes it easier to notice any changes in your breasts from
one month
to another.
Some health professionals suggest that, at first, women do BSE every day for a month so
that they really know the "geography" of their breasts. Early discovery of a
change from what is normal is
the whole idea behind BSE.
The best time to do BSE is 2 or 3 days after the end of your period, when your breasts are
least likely to be tender or swollen. A woman who no longer has periods may find it
helpful to pick a particular day, such as the first day of the month, to remind herself
that it is time to do BSE.
If you discover anything unusual, such as a lump, a discharge from the nipple, or dimpling
or puckering of the skin, you should see your doctor at once.
How To Do Breast Self-Examinations
1. Stand before a mirror. Look carefully at both breasts. Check for anything unusual, such
as any discharge from the nipples, puckering, dimpling, or scaling of the skin.
2. Watching closely in the mirror, clasp your hands behind your head and press your hands
forward. Look for any changes in the shape or contour of your breasts.
3. Next, press your hands firmly on your hips and bow slightly toward your mirror as you
pull your shoulders and elbows forward. Again, check for any changes in the shape or
contour of your breasts.
4. Raise your left arm. Use three or four fingers of your right hand to explore your left
breast firmly, carefully and thoroughly.
Beginning at the outer edge, press the flat part of your fingers in small circles, moving
the circles slowly around the breast. Gradually work toward the nipple.
Be sure to cover the entire breast. Pay special attention to the area between the breast
and the underarm, including the underarm itself. Feel for any unusual lump or mass under
the skin.
5. Gently squeeze the nipple and look for a discharge. (If you have any discharge during
the month -- whether or not it is during a breast self-examination -- see your doctor.)
Repeat steps 4 and 5 on your right breast, using your left hand.
6. Steps 4 and 5 should be repeated lying down. Lie flat on your back with your left arm
over your head and a pillow or folded towel under your left shoulder.
This position flattens the breast and makes it easier to examine.
Use the same circular motion described earlier. Repeat the exam on your right breast.
If you notice changes, call or see your physician.
Many women have irregular or "lumpy" breasts. The term "benign ,breast
condition" refers to those changes in a woman's breasts, that are not cancerous. Many
doctors believe that nearly all
women have some benign breast changes after age 30. But any change is best diagnosed by
your doctor.
Other Methods Used For Early Detection
Currently, manual breast exams and mammography are the most common and useful techniques
for finding breast cancer. However, several other methods are also being used.
Ultrasound detects breast changes by sending high-frequency sound waves into the breast.
The pattern of echoes from these sound waves is converted into an image of the breast's
interior.
Ultrasound may be helpful in distinguishing between solid masses and cysts (fluid-filled
sacs). Unlike mammography, ultrasound cannot detect small calcium deposits that may be
present in the
breast and that sometimes indicate cancer, nor does it identify small tumors.
Thermography measures heat patterns given off by the skin. Changes in the image, including
"hot spots," may suggest the presence of a breast problem. There is no known
risk of using
thermography, but it is not reliable enough to replace mammography.
Diaphanography, or transillumination, shines a bright light, through the breast.
Transillumination can show the difference between a solid tumor and a cyst. Current
studies indicate that
this method does not identify the very small cancers that can be detected by mammography.
Source: U.S. Dapartment of Health & Human Services, National
Cancer Institute
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